Dry Eye

Dry Eye = inadequate supply or quality of tear film in the eye to keep its surface smooth and clear, and thus well and comfortable

Common Symptoms

A sensation of burning, inflammation, stinging, and/or scratchiness in the eye (s)

Extreme tearing

Redness

Stringy mucus excretions in or around the eye (s)

Exacerbated irritation when exposed to smoke, wind, or other elements

Fatigue within the eyes

Increased light sensitivity

A sensation of a foreign body within the eye (s)

Great difficulty and discomfort in wearing contact lenses for extended periods of time

Blurred and impaired vision, usually becoming worse either after focusing the eyes for an extended period of time or at the end of the day

A feeling of being unable to keep the eyes open for long

Risk Factors

Advanced Age

Radiation Eye Therapy

Extensive-Wear Contact Lenses

Sensitivity to Certain Climates

Gender

More common in women, especially during pregnancy and menstruation and after menopause

Sjögren’s Syndrome

A chronic autoimmune disorder that is marked by the destruction of those glands that are responsible for the production of tears and saliva

Other Diseases

The co-occurrence of other conditions such as lupus, rheumatoid arthritis, and some thyroid diseases may lead to the development of dry eyes

Medication

There are some over-the-counter and prescription treatments that could reduce the amount of tear secretion in the eye (s)

Laser Surgery

LASIK and other refractive surgeries that may result in the decreased ability of sensation in the cornea could lead to dry eye

Dieting

Those diets that are low in Vitamin A, which is crucial for having and maintaining good vision, or Omega-3 fatty acids, which are vital for normal vision development in children and help protect the eyes from certain diseases, may lead to the contraction of dry eye

Causes

Poor Quality of Tears

The film of tears within the eyes are composed of three key layers:

1) Oil

2) Water

3) Mucus

Any flaws or defects in any of these layers can result in the causation of dry eye

1) Oil

The outer layer produced by the meibomian glands, the oil glands in the eyelids

The glands release lipids in order to smooth out the tear surface and slow down evaporation of the water layer of the tears

Inadequate oil production leads to a rapid evaporation of the water layer, which results in dry eye (s)

The condition is common in those people whose meibomian glands are clogged or impaired, such as with the diseases blepharitis, rosacea, and other skin diseases

2) Water

The middle layer of tear film that is composed of mostly water with a small bit of salt

It is produced by the lacrimal (tear) glands and is responsible for the cleansing of the eyes via the removal of any foreign bodies or irritants

Inadequate water production results in the possible contact of oil and mucus layers, which may lead to stringy mucus secretions in or around the eye (s)

3) Mucus

The inner layer of tear film that helps distribute tears evenly over the surface of the eye

Inadequate mucus production leads to the formation of dry spots on the corneal surface

Inadequate Production of Tears

The medical designation of this condition is keratoconjunctivitis sicca

This may be due to several factors:

1) Advanced Age

The condition is common in those who are older than 50 since tear production slows down throughout the aging process

2) Post-Menopause

There is a lack of tears duel largely in part to hormonal changes

3) Other Medical Conditions

The conditions aforementioned have already laid the groundwork for dry eye (s) to also develop

4) Laser Eye Surgery

If this types of procedure causes dry eye (s), then the symptoms that are experienced are only temporary

5) Damaged Lacrimal Glands

Inflammation or radiation can cause sufficient damage to these glands that tear production is retarded

Problems with the Eyelids

The process of blinking involves a continuous, even distribution of tear film across the surface of the eye

Problems such as an in-turning / out-turning of the eyelids (entropion / ectropion, respectively) can make blinking difficult and result in an effective spread of the tear film or rapid evaporation of the tears, which leads to dry eye (s)

Medication

Hormone Replacement Therapy

High Blood Pressure Drugs and Treatments

Certain Antidepressants

Antihistamines and Decongestants

Isotretinoin-type Drugs for Acne Treatment

Blinking Less Often

Many tasks require a level of concentration that causes one to blink far less often than normal

These tasks may include reading, driving, computer work, etc.

Diagnosis

Comprehensive Eye Examination

Some cases of dry eye (s) only requires the routine comprehensive eye examination for accurate diagnosis

Measurement of Tear Production

The Schirmer test involves the blotting of paper strips and placing them underneath the lower eyelids

After 5 minutes of initial placement, the ophthalmologist can measure the amount of the paper strips that were soaked by tears

Measurement of Tear Quality

There are some eyedrops that contain special dyes that can aid in the determination of the condition of the surface of the eye

The ophthalmologist checks for the staining patterns on the corneal surface and measures the amount of time it takes for the tears to evaporate

Treatment

Artificial Tears

These are used to treat those who experience a mild form of the condition and available without the need for a prescription

They can be used for improved lubrication and moisture maintenance

Preservative-Free Eyedrops

This treatment method is similar to artificial tears in that it is best suited for those who only experience the milder symptoms of the condition

This is an alternative to those who are allergic to the chemicals contained within artificial tears and/or need to use artificial tears at least six times a day

Additionally, these can be used as often as needed, from once or twice a day to as often as numerous times within an hour

Treatment of the Underlying Cause

Dry eye (s) can be undone by treating that which initially caused it

If the condition was caused by a medication, then it is advised to switch to a different medication to avoid that unfortunate and annoying side effect

For those cases in which it was caused by problems with the eyelids, then the ophthalmologist can recommend the patient to an oculoplastic surgeon, who specializes in plastic surgery of the eyelids

If the source of causation was an autoimmune disorder, such as Sjögren’s syndrome, then the patient may be recommended to a doctor who specializes in that particular disorder

Medication

Antibiotics

When inflammation of the eyelids causes the meibomian glands to malfunction, antibiotics in eyedrop, ointment, or pill form can be prescribed to reduce that inflammation